sábado, 18 de junio de 2011

Efectos de la morfina y el fentanil solos o combinados agregados a bupivacaína intratecal en anestesia raquídea para cesárea.

Efectos de la morfina y el fentanil solos o combinados agregados a bupivacaína intratecal en anestesia raquídea para cesárea.
The effects of morphine and fentanyl alone or in combination added to intrathecal bupivacaine in spinal anesthesia for cesarean section.
Karaman S, Günüsen I, Uyar M, Biricik E, Fırat V.
SourceDepartment of Anesthesiology and Reanimation, Ege University Faculty of Medicine, İzmir, Turkey. Semra.karaman@ege.edu.tr.
Agri. 2011 Apr;23(2):57-63.
Objectives: This randomized double-blind controlled trial examined the effects of fentanyl and morphine, alone and in combination, as adjuncts to spinal anesthesia for elective cesarean section. Methods: Sixty women undergoing elective cesarean section, with spinal anesthesia using 0.5% hyperbaric bupivacaine, were randomly allocated to receive morphine 0.2 mg, fentanyl 25 µg, or fentanyl 12.5 µg plus morphine 0.1 mg, intrathecally. The start of spinal block, the time to T10 level, the highest sensorial and motor block level, time to regression of sensory block to T10, time to resolution of motor block, surgical characteristics, maternal side effects, Apgar and NACS scores, umbilical blood gas evaluations, and time to first analgesic requirement were recorded. Results: No patient experienced pain during the intraoperative period. The degree and time of sensorial and motor block were similar in both groups, and there was no difference in time to T10 level and time to reversal of motor block. The difference in time to first postoperative analgesic requirement was statistically significant. There was no difference between groups in postoperative side effects. There were no neonatal differences in Apgar and NACS scores or umbilical blood gas evaluations. Conclusion: The quality of postoperative analgesia with morphine, when used alone, was found to be superior to that with fentanyl. The combination of opioids offered no advantages over morphine alone

Los requerimientos de bupivacaína intratecal para cesárea es similar en mujeres obesas y con peso nornal
Dose requirement of intrathecal bupivacaine for cesarean delivery is similar in obese and normal weight women.
Lee Y, Balki M, Parkes R, Carvalho JC.
Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Ontario, Canada.
Rev Bras Anestesiol. 2009 Nov-Dec;59(6):674-83.
BACKGROUND AND OBJECTIVES: The effect of BMI on the spread of intrathecal bupivacaine is controversial. This study assessed the ED95 of intrathecal bupivacaine for elective cesarean delivery in obese and normal weight women. METHODS: We studied normal weight (BMI < 25 kg x m(-2)) and obese (BMI > 30 kg x m(-2)) women with singleton term pregnancies undergoing elective cesarean delivery. The study was conducted as a single blinded, up-down sequential allocation study (modified by the Narayana rule). All patients received a combined spinal-epidural anesthesia with a variable intrathecal dose of hyperbaric 0.75% bupivacaine, plus fentanyl 10 microg and morphine 100 microg. The first patient received 9 mg of bupivacaine. Supplemental anesthesia was provided through the epidural catheter if required. The primary outcome was successful analgesia, defined as a sensory block to at least T6, and no request for supplemental anesthesia. The ED95 for the satisfactory outcome was determined by a logistic model with non-log-transformed doses. RESULTS: Twenty-four normal weight and sixteen obese patients were enrolled. The estimated ED95 for all forty patients was 12.92 mg (95% CI: 11.49 to 34.77). The estimated ED95 for the normal weight and the obese subgroups were similar at 12.78 mg (95% CI: 10.75 to + infinity) and 11.86 mg (95%CI: 11.31 to 15.61), respectively. CONCLUSIONS: If single shot spinal anesthesia is used for cesarean delivery, obese and normal weight patients should receive similar doses of hyperbaric bupivacaine. Although in our study the effective dose 95% could not be precisely determined, it is possible to state that it is at least 11.49 mg.

Bloqueo espinal con 10 mg de bupivacaína hiperbárica asociada con 5 microgramos de sufentanil para cesárea. Estudio de diferentes volúmenes
Spinal block with 10 mg of hyperbaric bupivacaine associated with 5 microg of sufentanil for cesarean section. Study of different volumes.
Braga Ade F, Frias JA, Braga FS, Pinto DR.
Seção de Anestesia, CAISM, UNICAMP.
Rev Bras Anestesiol. 2010 Apr;60(2):121-9, 69-73.
BACKGROUND AND OBJECTIVES: Several factors affect the cephalad dispersion of the anesthetic solution in the subarachnoid space; among them, physiological changes of pregnancy and the dose and volume of the local anesthetics should be mentioned. The objective of this study was to assess the effectivity and side effects of different volumes of the subarachnoid administration of the association of hyperbaric bupivacaine and sufentanil in cesarean sections. METHODS: Forty patients, ASA I and II, undergoing elective cesarean section under spinal block were divided in two groups, according to the volume of the anesthetic solution: Group I (4 mL) and Group II (3 mL). The association of hyperbaric bupivacaine (10 mg(2) mL) and sufentanil (5 microg-1 mL) was used in both groups. In Group I, 1 mL of NS was added to the solution to achieve the volume of 4 mL. The following parameters were evaluated: latency of the blockade; upper limit of the sensorial blockade; degree of motor blockade; time for regression of the motor blockade; total duration of analgesia; maternal side effects; and neonatal repercussions. RESULTS: Latency, the upper limit of the sensorial blockade, and the degree and time for regression of the motor blockade were similar in both groups; duration of analgesia was greater in Group I than in Group II, which was statistically significant. The incidence of side effects was similar in both groups. Maternal cardiocirculatory changes and neonatal repercussions were not observed. CONCLUSIONS: Four milliliter of anesthetic solution composed of hyperbaric bupivacaine, 10 mg, associated with 5 microg of sufentanil was more effective than 3 ml of the same solution, providing better intra-and postoperative analgesia without maternal-fetal repercussions

Dr. Benito Cortes-Blanco 
Anestesiología y Medicina del Dolor
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